Confederation of Health Care Systems

Israel – 2008

Lori Post

Yale University

School of Medicine

By the Year 2020

The next pandemic will have concluded

The UN will send a mandate to the World Health Organization

The WHO will generate a resolution to prevent another pandemic

WHO Request for Proposals

1. Why did it happen?

2. Damage – Mortality, Morbidity, Cost

3. What could we have done?

Why?

Every ~100 years, avian flu sweeps through the world

Large human population without immunity

Densely populated Asymptomatic during transmission Global population exposure Cytokine storms

Damage

TBD

Flu Pandemic Phase 1: No new influenza virus subtypes have been detected

in humans. Phase 2: No new influenza virus subtypes have been detected

in humans, but an animal variant threatens human disease. Pandemic alert period: Phase 3: Human infection with a new subtype but no human-

to-human spread. Phase 4: Small cluster with limited localized human-to-human

transmission Phase 5: Larger cluster but human-to-human spread still

localized. Pandemic period: Phase 6: Increased and sustained transmission in general

population.

Public Health Surveillance

Ongoing, systematic collection, analysis, and interpretation of data (e.g., regarding agent/hazard, risk factor, exposure, health event) essential to the planning, implementation, and evaluation of public health practice, closely integrated with the timely dissemination of these data to those responsible for prevention and control.

Early Surveillance

1854 John Snow Began with a cholera outbreak in London No technology First example of data collection and

spatial display of health issue Broad Street Water Pump clusters

Solution

Data collection and display Break the chain of transmission Public Health Resolution –

REMOVE the HANDLE Technology sufficient in 1854 but not in

2018

1800s 1900s 2000s

Positive Population MovementRuralSmall Population

Rural ICTKnowledge

Negative Transmission Knowledge

Transmission KnowledgePopulation Movement

ICTPopulation MovementUrbanLarge Population

Risk and Protective Factors for Infectious or Contagious Disease

1918 Flu Pandemic

~100 Million People Died 2 x number killed in WWWI Epicenter in Spain

2015 Flu Epicenter in rural Asia Disparate information and control measures Surveillance – passive, confederation, disparate Poor use of Information Communication Technology Slow response Global transmission before identification Population movement (1000s flights out of Asia every

day) Healthy population affected The technology to prevent the pandemic of 2015 was

developed in 1995

What could we have done?

Standardized data collection and aggregation Active Universal Health Surveillance System Early Identification Public Health Information Dissemination Containment until vaccine developed (2nd and

3rd Waves) Stockpiles of life sustaining medicines Global solution beyond political boundaries

Borders and Health Care Systems

3077 county health care systems Complicated passive system in US: County to

State to CDC to WHO The next avian flu will begin where there is

little to no surveillance Universal Health Care could be used for

primary, secondary, tertiary prevention for number of public health and social issues